Incidence and associated factors for hypotension after spinal anesthesia during cesarean section at Gandhi Memorial Hospital Addis Ababa, Ethiopia

Tewoderos Shitemaw, Bedru Jemal, Temesgen Mamo, Luelayehu Akalu, Tewoderos Shitemaw, Bedru Jemal, Temesgen Mamo, Luelayehu Akalu

Abstract

Background: Spinal anesthesia is a type of regional anesthesia that has been practicing for obstetric anesthesia since the beginning of the 20th century. Despite the simplicity and lower maternal mortality risk, compared to general anesthesia, spinal anesthesia is linked to different adverse effects, of which hypotension is the most common complication. The main aim of this study was to determine the incidence and associated factors of hypotension after spinal anesthesia during cesarean section.

Method: Institution-based cross-sectional study was conducted with 410 clients. The study was conducted on cesarean section under spinal anesthesia from 5th January to 30th April 2019, at the Gandhi Memorial Hospital, Addis Ababa, Ethiopia. Both bivariable and multivariable logistic regression analysis were done on the associated factors. The level of statistical significance was represented at p<0.05.

Results: The incidence of hypotension among mothers who underwent a cesarean section after spinal anesthesia was 64%. Newborn weight ≥4kg (AOR = 5.373; 95%CI: (1.627-17.740)) showed an increase risk of association with hypotension. A baseline systolic blood pressure < 120mmHg (AOR = 6.293; (95%CI: 2.999-13.204)) was found to be associated with increased risk of hypotension. Sensory block height >T6 AOR = 2.230; 95%CI: (1.329-3.741), the time interval between spinal induction and skin incision > 6minutes AOR = 1.803; 95%CI: (1.044-3.114) and anesthetist experience AOR = 5.033(95%CI: 2.144-11.818) were also associated with hypotension.

Conclusion: The identified risk factors for hypotension, after spinal anesthesia are sensory height block, weight of the baby, the time interval between spinal induction and skin incision, baseline systolic blood pressure, and anesthetist experience.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Baseline SBP of clients who…
Fig 1. Baseline SBP of clients who underwent cesarean section under spinal anesthesia.
Fig 2. Types of hypertension.
Fig 2. Types of hypertension.
Fig 3. Incidence of hypotension among women’s…
Fig 3. Incidence of hypotension among women’s who undergone cesarean section under spinal anesthesia.

References

    1. Shikur B, Marye A, Mesfin E. Spinal anesthesia for cesarean delivery at two teaching hospitals in Addis Ababa, Ethiopia. Ethiopian Medical Journal. 2018. February 27;56(2).
    1. Lamacraft G (Principal Specialist in Anaesthesia) (2004) Complications associated with regional anaesthesia for Caesarean section, Southern African Journal of Anaesthesia and Analgesia, 10:1, 15–20, 10.1080/22201173.2004.10872346
    1. Higuchi H, Hirata J, Adachi Y, Kazama T. Influence of lumbosacral cerebrospinal fluid density, velocity, and volume on extent and duration of plain bupivacaine spinal anesthesia. Anesthesiology. 2004;100(1):106–114. 10.1097/00000542-200401000-00019
    1. Bajwa SJ, Bajwa SK, Kaur J, Singh A, Singh A, Parmar SS. Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: A randomized study with intrathecal clonidine. Int J Crit Illn Inj Sci. 2012;2(2):63–69. 10.4103/2229-5151.97269
    1. Morgan PJ, Halpern SH, Tarshis J. The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review. Anesth Analg. 2001;92(4):997–1005. 10.1097/00000539-200104000-00036
    1. Somboonviboon W, Kyokong O, Charuluxananan S, Narasethakamol A. Incidence and risk factors of hypotension and bradycardia after spinal anesthesia for cesarean section. J Med Assoc Thai. 2008;91(2):181–187.
    1. Brenck F, Hartmann B, Katzer C, et al. Hypotension after spinal anesthesia for cesarean section: identification of risk factors using an anesthesia information management system. J Clin Monit Comput. 2009;23(2):85–92. 10.1007/s10877-009-9168-x
    1. Ohpasanon P, Chinachoti T, Sriswasdi P, Srichu S. Prospective study of hypotension after spinal anesthesia for cesarean section at Siriraj Hospital: incidence and risk factors, Part 2. J Med Assoc Thai. 2008;91(5):675–680.
    1. Chumpathong S, Chinachoti T, Visalyaputra S, Himmunngan T. Incidence and risk factors of hypotension during spinal anesthesia for cesarean section at Siriraj Hospital [published correction appears in J Med Assoc Thai. 2006 Oct;89(10):1804]. J Med Assoc Thai. 2006;89(8):1127–1132.
    1. Upadya M, Bhat S, Paul S. Six percent hetastarch versus lactated Ringer’s solution—for preloading before spinal anesthesia for cesarean section. Anesthesia, Essays and Researches. 2016. Jan-Apr;10(1):33–37. 10.4103/0259-1162.16472
    1. Maayan-Metzger A, Schushan-Eisen I, Todris L, Etchin A, Kuint J. Maternal hypotension during elective cesarean section and short-term neonatal outcome. Am J Obstet Gynecol. 2010;202(1):56.e1–56.e565. 10.1016/j.ajog.2009.07.012
    1. Fakherpour A, Ghaem H, Fattahi Z, Zaree S. Maternal and anaesthesia-related risk factors and incidence of spinal anaesthesia-induced hypotension in elective caesarean section: A multinomial logistic regression. Indian J Anaesth 2018;62:36–46 10.4103/ija.IJA_416_17
    1. Richard B, Alan JR, Vincent WS. Spinal, epidural, and caudal anesthesia In: Miller RD, Eriksson LI, Wiener-Kronish JP, Young WL editors. Miller’s anesthesia. 8th ed Philadelphia, PA: Saunders, an imprint of Elsevier Inc; 2015. 1684–1720.
    1. Kinsella SM, Carvalho B, Dyer RA, et al. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73(1):71–92. 10.1111/anae.14080
    1. Wang X, Xu JM, Zhou F, He L, Cui YL, Li ZJ. Maternal position and development of hypotension in patients undergoing cesarean section under combined spinal-epidural anesthesia of intrathecal hyperbaric ropivacaine. Med Sci Monit. 2015;21:52–58. Published 2015 Jan 5. 10.12659/MSM.892224

Source: PubMed

3
Předplatit